Continuous Improvement and the Expansion of Quality ... - NCQA

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T H E S TAT E o f H E A l T H C A R E Q U A l I T y 2 0 1 1 • H E D I S M E A S U R E S o f C A R E • Each year, preventable adolescent deaths cost an estimated $33.5 billion in direct medical costs, and lifetime indirect and direct costs are more than $700 billion. 10 for those that survive, the total lifetime medical costs for these individuals is estimated to be $25 billion. 9 HEdIs Measure definition The percentage of enrolled adolescents and young adults 12–21 years of age who had at least one comprehensive well-care visit with a primary care practitioner or an ob/GyN practitioner during the measurement year. results While most adolescents are healthy, changes in their physical and social circumstances put them at increased risk for serious and longterm health effects of risky behaviors. yearly well-care visits offer primary care providers the opportunity to provide the screening and health counseling services adolescents need to stay healthy. yEAR 89 at lEast onE CoMPrEHEnsIvE WEll-CarE vIsIt CoMMERCIAl MEDICARE MEDICAID HMo PPo HMo PPo HMo 2010 42.7 39.2 NA NA 48.1 2009 42.5 38.3 NA NA 47.7 2008 42.9 36.2 NA NA 45.9 2007 41.8 34.7 NA NA 42.1 2006 40.3 34.6 NA NA 43.6 2005 38.8 29.3 NA NA 40.7 2004 38.2 NA NA NA 40.0 2003 37.1 NA NA NA 37.5 2002 35.8 NA NA NA 37.1 2001 33.1 NA NA NA 32.6 2000 30.9 NA NA NA NA 1999 28.9 NA NA NA NA M E A S U R E S T A R G E T E D A T C H I l D R E N A N D A D o l E S C E N T S
M E A S U R E S T A R G E T E D A T C H I l D R E N A N D A D o l E S C E N T S 90 • In 2007, more than five million children 0–17 years of age had no usual source of care; the same number had one or more unmet medical need during the year. Almost six million children were without a doctor or nurse who knew their medical history. 4 N AT I o N A l C o M M I T T E E f o R Q U A l I T y A S S U R A N C E CHIlDREN AND ADolESCENTS’ ACCESS To PRIMARy CARE PRACTITIoNERS Children and adolescents need access to primary care practitioners (PCP) to ensure their optimal health and well-being. 1 PCPs play an important role in preventing illness and death in the young. 2 The Children and Adolescents’ Access to Primary Care Practitioners measure assesses whether children and adolescents were able to obtain medical attention from a PCP, such as a family doctor, internist, pediatrician or general practitioner. • Although the primary care workforce increased by 35 percent between 1996 and 2006, almost one million children live in areas with no PCP. Children and adolescents living in rural areas are affected disproportionately. 5 the Case for Improvement • fewer than half of children and adolescents in the United States receive the recommended amount of preventive care. 3 • Accessible primary care reduces hospital use and maintains quality of care. 6 Access to primary care is an effective way to reduce expensive hospitalizations and curb rising health care costs. 7 • for adolescents, inaccessible care can put them at risk for developing chronic disease, substance-use disorders and risk-taking sexual behaviors. 8-10 HEdIs Measure definition The percentage of children and young adults 12 months to 19 years of age who had a visit with a PCP. The measure reports on four separate percentages: • Children 12–24 months who had a visit with a PCP during the measurement year • Children 25 months–6 years who had a visit with a PCP during the measure year • Children 7–11 years who had a visit with a PCP during the measure year or the year prior to the measurement year • Adolescents 12–19 years who had a visit with a PCP during the measurement year or the year prior to the measurement year.
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140 N AT I o N A l C o M M I T T E
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158 APPENDIx 8: PUblICly REPoRTING
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172 MEASURE N AT I o N A l C o M M
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184 REfERENCES N AT I o N A l C o M
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ACkNoWlEDGMENTS Health Plans The 20
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Continuous Improvement and the Expansion of Quality ... - NCQA

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